Pulmonology Coding Alert
Correctly Code Neurostimulator Use For Patients With Sleep Apnea
Patients who fail CPAP may be excellent candidates for this cutting-edge service. Some patients with OSA and CSA require continuous airflow from an external machine to enjoy a full night’s rest. However, implantable devices that stimulate the body’s nerves can be a better option for patients who don’t respond to traditional sleep apnea treatments. Understand how to correctly code neurostimulator surgical encounters to ensure accurate reimbursement. Learn the Different Types of Sleep Apnea Sleep apnea is a sleep disorder that can have potentially dangerous results depending on the severity of the condition. When a patient suffers from sleep apnea, their breathing periodically stops and starts, they may snore loudly, or they may gasp for air while sleeping. Providers often prescribe a continuous positive airway pressure (CPAP) machine that delivers constant air pressure to help keep the patient’s airway open when they inhale while sleeping. However, some patients don’t benefit from a CPAP machine, are unable to use the device, or simply fail CPAP treatment for several reasons. “People can have claustrophobia. Some people can’t stand the pressure. The masks leak no matter what mask [the patient] tries. Some people throw it off in the middle of the night without even knowing it — they wake up and it’s on the bedroom floor,” says Timothy Dettmer, MD, otolaryngologist at Mason City Clinic in Mason City, Iowa. When the patient fails traditional treatment options for obstructive sleep apnea (OSA) or central sleep apnea (CSA), the provider may choose to use nerve stimulation methods to treat the patient’s condition. Get to Know the Hypoglossal Nerve Stimulation Device Codes OSA, coded to G47.33 (Obstructive sleep apnea (adult) (pediatric)), is when the patient experiences intermittent disruptions in their breathing while sleeping. When a patient is asleep, the muscles and soft tissue in the tongue and throat area relax, which causes them to collapse on the throat and block airflow. Other factors can also contribute to the condition including hormonal changes, large tonsils, or obesity. Providers will perform a sleep study to evaluate the patient and diagnose them with OSA. After suggesting healthy lifestyle changes, a provider may prescribe a CPAP machine. If the patient fails the CPAP treatment, they may be a candidate for a hypoglossal nerve stimulation procedure. Upper airway stimulation (UAS) — also known as hypoglossal nerve stimulation (HNS) — uses a medical device implanted in the patient’s chest with an electrode connected to the tongue’s hypoglossal nerve. “Hypoglossal nerve stimulation is a surgical procedure that assists patients with OSA,” said Michelle Mesley-Netoskie, COPM, CPC, CPB, COC, CRC, CPPM, CPMA, CPC-I, revenue cycle management specialist at Albany ENT & Allergy Services during AAPC’s “ENT Procedures, Surgeries and Other Hot Topics” webinar. The hypoglossal nerve is a motor nerve in the tongue that activates the muscles, and allows the muscles to narrow, curve, and shorten the tongue. With an implanted UAS device, the hypoglossal nerve is stimulated while the patient sleeps, causing the tongue to gently move forward away from the patient’s airway to enable proper airflow. In the CPT® code set Index, search for Neurostimulators, followed by Hypoglossal Nerve Stimulator Array to locate the code range. When you verify the codes, you’ll find three codes designated for HNS device procedures: You’ll assign 64582 to report the device implantation. If the provider revises the device or replaces the HNS device, then you’ll assign 64583. Lastly, you’ll assign 64584 if the provider removes the device from the patient. Refer to Category III Codes for Transvenous Phrenic Nerve Stimulation Procedures CSA, coded to G47.31 (Primary central sleep apnea), is a rare sleep disorder where the patient’s breathing stops during sleep because the patient’s brain fails to transmit proper signals to the muscles that control the heart rate and breathing. The provider will order a full-night or split-night sleep study with polysomnography to evaluate the patient for possible CSA. If the provider diagnoses the patient with CSA, the provider has several treatment options available, including CPAP. Patients diagnosed with OSA aren’t the only ones who can benefit from nerve stimulation. In recent years, the U.S. Food and Drug Administration (FDA) approved a transvenous phrenic nerve stimulation device for CSA treatment, and a study is currently underway across the country to test the effectiveness of the therapy for patients diagnosed with CSA (https://clinicaltrials.gov/ct2/show/NCT03884660). Several Category III codes are related to the implantation, revision, removal, and evaluation of the transvenous phrenic nerve stimulation device and its components. Some of the codes include, but are not limited to: According to the American Medical Association (AMA) Category III codes are “intended to be used for data collection to substantiate widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process” (www.ama-assn.org/practice-management/cpt/category-iii-codes). The data collected from Category III codes helps the AMA determine if the codes should be established at a Category I level in the future. Remember to Check Payer Policy Before a patient is eligible for HNS or transvenous phrenic nerve stimulation, they’ll need to meet several criteria, and not every patient is eligible for the devices. For example, “[HNS] is an item that you have to check payer policy for because the vendors have specific criteria based on their clinical testing, and the insurance companies have medical necessity policies, as well,” Mesley-Netoskie said. For instance, some of the medical necessity criteria listed in Palmetto GBA’s local coverage determination (LCD) for HNS for OSA to include: For the complete LCD, go to www.cms.gov/medicare-coverage-database/search.aspx and search for L38276.
Related Articles
Pulmonology Coding Alert
- Coding 101:
Keep Your Ventilator Management Claims Compliant With These 3 Tips
Learn the rules for vent management and E/M coding. Assigning the correct ventilation management codes [...] - Reimbursement:
Can You Report 31645 for Multiple Outpatient Therapeutic Aspirations? Find Out
Recognize the restrictions of a DOS edit. Occasionally, a medical report will come across your [...] - Nerve Stimulation:
Correctly Code Neurostimulator Use For Patients With Sleep Apnea
Patients who fail CPAP may be excellent candidates for this cutting-edge service. Some patients with [...] - You Be the Coder:
Understand What ‘Diagnostic’ Means for Bronchoscopies
Question: AMA CPT® guidelines state, “Surgical bronchoscopy always includes diagnostic bronchoscopy when performed by the same [...] - Reader Question:
Are New Patients Billable as Incident To?
Question: During a new patient encounter, the nurse practitioner (NP) documented the initial history and performed [...] - Reader Question:
Sift Through SDOH Codes to Report Patient Noncompliance
Question: A patient came in for a follow-up evaluation and management (E/M) visit for their moderate [...] - Reader Question:
Check Your State Laws for HIPAA Expiration Requirements
Question: Our patient forms pertaining to HIPAA have an expiration date of one year from the [...]
